Guardianship Request

MHA’s 17-A Guardianship Program aids families with children and adults with intellectual and developmental disabilities in Orange County. There is a $300 fee for this service which will be payable to Mental Health Association in Orange County, Inc. at or before the initial meeting with the Guardianship Associate. The fee may be paid by cash, personal check, bank check or money order. The fee covers assistance for 12 months following the initial meeting. If you have not completed the process and need further assistance after 12 months, there will be an additional fee of $75.

Individual's Name Individual's Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Diagnosis/Disability
Contact Name Contact Name First Last
Relationship to Individual
Email
Phone Phone - ### - ### ####
Preferred Method of Contact

Preferred Method of Contact Text Email Phone Call
Brief Reason for Guardianship Request